medicare/medi-cal discharge supplies

  1. the board has been so helpful before---need it again...want to discharge a patient from HH with wound care supplies. Medicare/ Medi-Cal. Suppliers won't do it; state go thru pt pharmacy. NO pharmacy wants to do it either. Suppliers will do direct billing for medi-cal, but won't do the medicare/medi-cal shuffle. I guess I'm ignorant when it comes to this, would appreciate any help...
    Thanks
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    About CWOCN

    Joined: Oct '02; Posts: 22

    2 Comments

  3. by   renerian
    Under the home health benefit while you are servicing the client medicare dressings are bundled or need to be provided to the client at no charge. The dressings are part of the reimbursement the agency is paid for during the care. Under Medicaid (in OHIO) it will cover the dressings but they, the supplier, should bill you for the dressings while in the home health agencies care. After d/c they should bill his Medicaid /Medical number. Does that make sense?

    renerian
  4. by   hoolahan
    I don't see why you should have a problem discharging a pt with a week or few days worth of supplies. I would think it would be your agency stopping you from ordering too much. My agency policed every 4x4 ordered.

    Anyway, it is my understanding you want to help this pt obtain supplies after discharge. If the DME suppliers won't try to bil and get reject from Medicare first, and won't take Medi-cal upfront, and I assume you have tried several DME suppliers, not just the ones your HH agency uses, I would think there is only one way to go about this.

    The pt wil have to pay ufront, then submit the bill to Medicare himself, then when he gets a denial, send the bill to Medical I I never heard of medical is that medicaid california style?)

    Obviously this is stupid, b/c if someone qualifies for caid, then they theorectically cannot afford the cost of meds, etc... How is he getting his meds?? That is usually the way pharmacies have to do it, so I am wondering why his pharmacy won't??

    If you don't get a reasonable answer, I would try to speak to someone in your local offices of both medicare and medical, and ask how to go about this? Ask to file a quality complaint. Specifically, why the patient cannot sign an ABN for the DME suppliers, like they do in homecare.

    Keep trying orther DME companies, there must be someone out there who can ship the supplies and wil do this. It doesn't have to be a local company.

    Good luck, how utterly frustrating a situation this is!!!

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